Stark shift in BP care since ASCOT

Experts express concern as use of diuretics plunges and ACE inhibitor scripts soar following ASCOT trial

The landmark but controversial ASCOT trial has transformed the face of hypertension care in the UK, an analysis for Pulse reveals.

New prescriptions of calcium channel blockers and ACE inhibitors have soared since results from ASCOT were released – whereas use of diuretics has plummeted.

Leading hypertension specialists reacted with concern to the findings, suggesting GPs might have been 'inappropriately' swayed by the results of ASCOT, which backed a calcium channel blocker and ACE inhibitor as the best combination.

They said the fall in use of diuretics was 'worrying' and 'perverse'. NICE guidance, which followed ASCOT and was released in June 2006, recommended either calcium channel blockers or diuretics as first-line treatments.

Analyst Cegedim Strategic Data provided Pulse with data for new prescribing opportunities – either new hypertension patients or those switched from one drug to another.

There were 282,044 scripts for calcium channel blockers written in February 2005 – the month before results from ASCOT were released. By December 2006, this was 414,662. Use of ACE inhibitors leapt from 314,678 to 475,492 new scripts in the same period.

Meanwhile, the number of new diuretic scripts fell from 396,490 in June 2005 to 254,538 in December 2006, and ß-blockers from 235,527 to 100,119.

Professor Morris Brown, president of the British Hypertension Society, expressed concern at the extent to which ASCOT appeared to have influenced doctors. He said: 'It's perverse to ignore the only drug we are sure is directly opposed to what's causing hypertension.'

Dr Bill Cushman, chair of the dissemination committee for the US ALLHAT trial, which supported use of diuretics first line, also felt the findings were 'unfortunate'.

He said: 'It's worrying because a diuretic is clearly superior to an ACE inhibitor in preventing strokes and heart failure. It's an inappropriate interpretation of the study.'

But Dr Mark Davis, a member of the executive committee of the BHS and a GP in Leeds, insisted the stark changes represented an improvement in quality of care.

'Since guidelines from the BHS and good pragmatic guidance from NICE, primary care in the UK is doing a much better job in managing hypertension,' he said.